NFDN 2007 Mental

Health
Unit 1.1
Introduction

Nurse
for 32
years

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Have 2 Mother
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 Contact Information
• Email: Karen.joy@norquest.ca
• Phone: (780) 644-6316
• Office: CELT 8-207.57
• My office hours are open- please email
me to make appointment
• Best way to reach me is by email
Unit 1.1- Introduction to
Mental Health Nursing
 Hello!
Review:
- Syllabus
- Assignments
- Expectations
Documentary
Documentary – To Kill or Cure: A history of
Medical treatment
(Madness: A History)

Top 10 HORRIFYING Mental Asylums

https://youtu.be/eF1pUtxMI2g
Unit 1 Topic 1.1
Introduction to Mental Health Nursing
Mental Health
oWhat is it?

oWhat does it mean to you?

Retrieved April 4, 2018
From WHO.com
Retrieved April 9, 2019 from:
Canadian Institute of Health Information
https://www.cihi.ca/en/child-and-youth-mental-health-in-canada-infographic
Retrieved April 9, 2019 from:

Canadian Institute of Health Information

https://www.cihi.ca/en/child-and-youth-mental-health-in-canada-inf
ographic
History and Evolution
Evolution History

• Home to Hospital to Community • What effect did World War 11

have on Mentally ill Patients?
• Hospitals were called Insane
Asylums as well as Mad Houses. • PTSD
• Shift from hospital to community
Mental Health and Mental Disorder
• Describe Mental Health
– In the past?
Possessed by devil, witch, holes put in heads, Latin spirits, sinning, torture,

– Today?
• Stigmas but have drug treatments
Describe the characteristics, behavior and
abilities of someone who is mentally healthy
Mental Health and Mental Disorder
• Describe Mental Disorder

• Describe the characteristics, behavior and abilities of someone

who is mentally ill?

• What images come to your mind?

• Where do those come from?

What is Mental Illness?
• Term used to mean all diagnosable mental disorders.
• A mental disorder is a health condition characterized by
alterations in a variety of factors that include mood and affect,
behaviour, thinking and cognition
Glossary A,K,T&B 4rd p 954
Mental Health and Mental Disorder
• Optimal mental health and
Minimal mental health: Maximum
mental disorder and Absence of
mental disorder - represent the
extremes
• Two separate simultaneously
occurring continua (p18)
• A person without a mental
disorder CAN experience minimal
mental health
• A person with a maximum mental
disorder CAN experience optimal
mental health
Stop and Consider:

• Can mental health be possessed even in the

presence of Mental Illness?

• See textbook page 17 - 18

Mental health and Mental disorder

• Are the behaviors of a mentally ill person so

strange they are beyond the understanding of
society?

• Behaviors of the mentally Ill are exaggerations of

expected human behavior --- this is a basic assumption
on human behavior used to assess psychiatric clients.
Risk Factors
• Any factor that increases the chances of an individual to develop
mental illness.
• Homelessness and Cultural factors have been deemed to be most
significant in contributing to mental illness development.
• There is significant evidence on genetic predisposition.
What are the social determinants of health?

The primary factors that shape the health of Canadians are not
medical treatments or lifestyle choices but rather the living
conditions they experience. These conditions have come to be
known as the social determinants of health.
Social Determinants of Health “The Canadian Facts” by Mikkonen, J. & Raphael, D. (2010)
 These five key areas (determinants) include:
• Economic Stability
• Education
• Social and Community Context
• Health and Health Care
• Neighborhood and Built Environment
Which ones affect mental health?
Which one(s) affect the most?
Stigma and Mental Illness
• What does Stigma mean?

• What are the social stigmas associated with Mental Illness?

• What is the impact of social stigma on persons with Mental

Illness?

o https://www.youtube.com/watch?v=KFnwJg_4uwM
 Stigma and Mental Health
• Do you have any stigmas?

• What does discrimination mean related to mental health?

• What does stereotyping mean related to mental health?

• What does prejudice mean related to mental health?

• See page 30 of text

 Definitions
• Stigma: the mark of a spoiled identity. A form of
prejudice that spreads fear and misinformation,
labels individuals, and perpetuates stereotypes.
– Negative unfavorable attitudes and the behavior they
produce associated with a particular trait displayed by or
activity engaged in bay an individual

• Discrimination: the differential treatment of others

because they are members of a particular group or
identified as being negatively different…. Arises
from a lack of understanding and appreciation of
differences among people, but it can be overcome.
 Definitions cont’d.
• Stereotyping: expecting individuals to act in a
characteristic manner that conforms to a usually
negative perception of their cultural group….occurs
because of lack of exposure to enough people in that
particular group.

• Prejudice: a hostile attitude towards others simply

because they belong to a particular group that is
considered to have objectional characteristics .
National Mental Health Strategy
• Between 2003-2006 a federally funded committee reviewed Canada’s
mental health system.

• The committee published four reports

• Final Report: “Out of the Shadows at Last: Transforming Mental Health,
Mental Illness and Addiction Services in Canada” ( Kirby & Keon2006)
• Proposed 118 recommendations
– Change Canadas approach to mental illness…. So that mental illness is seen as
important as other health concerns.
– Health education in mental health is key…. Becomes a catalyst for each person to
work toward optimal mental health.
 Opening Minds Initiative
• Mental health Commission of
Canada 2009 ( MHCC)
• 10 year long anti-stigma campaign

Goal:
• Change Canadas behaviors and
attitudes towards mental illness
• So – those with mental illness will
seek treatment and support
 Target Groups
• Youth

• Health Care Providers

• Workforce

• News Media

WHY these targets??

Contact Based Education/Existing programs
• People who live with Mental Illness

• Share their stories and experiences of illness, stigma and

recovery.
Stop and Consider….
• Your patient load has increased because a co-worker called in
sick.
• Co-worker#1 has a diagnosis of Type II diabetes.
• Co-worker#2 has a diagnosis of Major Depressive disorder.

• What are your feelings? Which co-worker are you more

understanding with?
Stop and Consider…
• You walk into a room and find our client crying.

• Client # 1 has recently returned from surgery and is in pain.

• Client # 2 doesn’t like the food and hates his life. Everything
“sucks”

• What are your feelings? Which client do you have more empathy
with?
Context of Mental Health Care
• The three contexts of Mental Health and Mental Illness in Canada
– Cultural
– Socioeconomic – four main social determinants
– (income, housing, nutrition and food, security and early
childhood development)
– Legal

– Along with specific behavior, context MUST be taken into

consideration when determining mental health or mental illness.
( Josh story HR)
 Cultural Context

• What is meant by culture?

– It is a way of life,
– How people identify with one another,
– Is based on a common need or similar background,
– Learned belief, values and behaviors.
• How does culture influence mental health?
A Saskatchewan Roughrider Fan
Stop and Consider
o A client is a huge fan of the Saskatchewan Roughriders and can’t wait to
watch the football game.

o When you enter the client’s room to administer his medication, you notice
the client has painted his face green and is wearing a watermelon on his
head.

o What must the nurse consider in her assessment?

Culture: Impact on Mental Health
o Do symptoms of mental illness manifest differently
across cultures?

o When cultural practices are denied to communities what

is the impact on mental health?

o Aboriginal People of Canada

https://youtu.be/9QMZaOVOin8
o Colonialism and Assimilation

o Residential Schools
• See your text p27
Canadian Multiculturalism Policies
o Multiculturalism Policy of Canada (1971)
o First country to adopt a policy of multiculturalism

o Affirms the rights, dignity and value of all Canadians

regardless of ethnic, linguistic or religious background

o Confirmed rights of indigenous people of Canada

o Recognized Canada’s two official languages

o Canadian Charter of Rights and Freedoms (1982)

o Reaffirmed the policy of 1971
 Cultural Competence
oWhat is Cultural Competence?

oIs it your responsibility to provide Culturally Competent Care?

oWhat is its relation to Cultural Safety?

o Cultural awareness
o Cultural sensitivity
o Cultural competence

ohttps://www.youtube.com/watch?v=V-50pFjGaBs
 Socioeconomic Context
o What is meant by ‘social determinants’?

o What are the four main social determinants of health?

o Income
o Social Status
o Nutrition & food security
o Early childhood development

o How do the social determinants influence mental health?

• See text p 33 and 14
Poverty in Canada
o What is poverty?

o What is the relationship between mental illness &

poverty?

o 1 out of 6 Canadian children lives in poverty

o 1 out of 4 First Nations children lives in poverty

(Campaign
2000,2006)
 Economic Impact (2011-2041
o In 2011Canada

o Each year --- 20% of Canadians experience a mental health

problem or illness

o Cost of mental illness was $42.3 billon in direct costs &

$6.3 million in indirect costs.

o Over the next 30 years ---- ^ in number of people living

with mental illness (aging pop & pop growth)
Legal Context
o What is the aim of mental health legislation?

o Protects, promotes & improves the lives and mental well-being of citizens

o Ensures adequate and appropriate care and treatment

o Right to medical care; right to privacy; right to judicial guarantees

(United Nations 1991)
 Mental Health in Alberta Today
o Mental health diagnoses most frequent diagnoses in primary care

o Ensure balance between prevention and treatment of mental illness

o Ensure health professionals are aware of mental health services in their

communities

o Enhance accessibility to resources in the community

Diagnosing Mental Disorders:DSM-5-TR
 DSM-5-TR
o Diagnostic & Statistical Manual of Mental
Disorders, 5th Edition, Text Revision

o Describes all mental disorders based on clinical

experience & research

o Commonly understood diagnostic category

o Used to accurately diagnose mental illness

DSM-5-TR--- Purpose
o Provide a standardized nomenclature & language

o Present defining characteristics or symptoms

o Assist in identifying the underlying causes of disorders

o Accurately diagnose mental illness

• Mental illness is diagnosed according to specific criteria
 DSM-IV: Previous Version
o 5 Axes allow for identification of factors that relate to a
person’s condition

Axis I All major psychiatric d/o

Axis II Personality disorders & mental retardation
Axis III Current medical conditions
Axis IV Stressors
Axis V Global Assessment Functioning
 DSM 5 - TR
oThe DSM-5 --- the multiaxial system is eliminated

oInstead:

o Medical and Mental Health Conditions (formerly

Axes1,II &III)

o Psychosocial and Contextual Factors (formerly Axis

IV)

o Disability (formerly Axis V)

oBox 2-1 p 20 B&A 3rd for diagnostic categories

It is possible that this subtle shift in coding may decrease
the stigma often associated with personality disorders.
 Alberta Mental Health Act

oProvincial Statue - Proclaimed in 1990

oUpdated from the Insanity Act
oBased on human rights – includes equality, right to
privacy & non-discrimination
oProtects the rights of mental health clients
oRegulates the admission, detention & treatment of
mentally ill people
oRegulates a client’s treatment and control
 Alberta MHA
Consists of:
1. Admission certificates
2. Judge’s warrant for apprehension
3. Police Officer’s power
4. Review Panel
5. Treatment orders
6. Control
7. Patient’s rights
MHA- Admission Certificate (Involuntary)
oMust be examined by a physician
oAll 3 criteria must be present:
1. Suffering from a mental health disorder
2. Likely to cause harm to themselves or others or to suffer
substantial mental or physical deterioration or serious physical
impairment
3. Unsuitable for any other type of admission

oAdmission certificate is good for 24 hour detention

oPlease see Mental Health Act on your Moodle
Continued
After 24 hours, 3 possible results:

1. Treat the client as voluntary

2. Discharge the client - condition is resolved
3. Issue a 2nd admission certificate - can be held up to 30 days
 Renewal Certificate
o Two physicians examine the patient separately – one must be a psychiatrist

o Each physician issues a renewal certificate

o 1st two are for 30 days, 3rd is for 6 months

o 3rd renewal – mandatory review by Review Panel
 Stop and Consider….
o A person arrives at the Emergency Room and is a voluntary admission to a
mental health unit.

o A few hours later the person wishes to leave.

o What is your response?

MHA- Judge’s Warrant
o Warrant issued provides the police with authority to apprehend, detain and
convey individual to a designated facility

o Warrant in effect for 7 days from time of issue

o Individual may be detained for 24 hours

MHA- Police Officer’s Power
oPeace Officer has the same authority as Admission Certificate

oPeace Officer may apprehend and convey a client to a facility if:

o Present a danger to self or others
o Client should be examined for own safety or safety of others

oValid for 24 hours from arrival at the facility

MHA- Review Panel
oHear cases relating to cancellation of admission or renewal
certificates, as well as treatment orders

oPanel is composed of:

o Chair, psychiatrist, physician, member of the general public
o Applicant and applicant’s representative
MHA- Treatment Orders
oIf client is deemed mentally competent but objects to treatment:
oReview panel is involved by physician

oReview panel can issue a treatment order when:

oClient will improve with treatment
oClient will deteriorate without treatment
oBenefit will outweigh risk of harm
oIt is the least restrictive/ intrusive treatment

oWhat happens if the client is deemed incompetent and refuses treatment?

MHA- Mandatory Outpatient Treatment
o What is MOT?

o Legal provisions requiring people with mental illness to comply with a

treatment plan while living in the community

o Involuntary patient returns to the community on a conditional leave if the

admission criteria are still met and if stipulations for treatment are followed

o Stipulations may include taking medication & meeting with physician

 MHA- Community Treatment Order
o What is a CTO?

o A comprehensive plan of community-based treatment to someone with a

serious mental disorder

o Issued for persons:

o With severe mental illness
o History of hospitalization
o Examined by a physician & deemed in need of continuing treatment
and care while residing in the community

o Less restrictive then a psychiatric facility

MHA- Control
oPhysician has the authority to control the client without the
client’s consent

oControl is:
o Minimal use of force
o Medication as is reasonable
o Threatening self injury = physical restraint
 MHA- Patient’s Rights
oRight to be informed (includes guardian/ next of kin)

oRight to appeal decisions (admission/treatment)

oRight to communications
o unlimited personal mail & telephone conversations
o includes privacy of such communication

oRight to visitors
Retrieved from MentalHealthCanada.com
Principlism Approach - Ethical Principles
• Beneficence
• Nonmaleficence
• Autonomy
• Justice
• Veracity

• Chapter 7 p 82 in textbook.
Nursing Code of Ethics

• Act with care and compassion • Stay informed on trends and

• Respect diversity and
confidentiality
• Adhere to the standards of
practice
issues
• Uphold position of trust
• Show No tolerance for abuse.
Any Questions?